Treatment-switch trumps resistant-depression in teens

New research has flagged the value of early aggressive antidepressant treatment in adolescents who have failed to respond to SSRIs.

The findings, which could change treatment guidelines, come from a study in which more than one-third of teenagers with this severe form of depression became symptom-free six months after switching their medication or combining a switch with cognitive behavioural therapy (CBT). The study, headed by Graham Emslie, professor of psychiatry and paediatrics at UT Southwestern Medical Center, Texas, also found that teenagers who showed an improvement of symptoms after just three months of their new regimen were much more likely to show lasting benefit. The findings will be published in the American Journal of Psychiatry.

In February 2008, Dr Emslie and colleagues first published work about these teenagers, who had failed to respond to a selective serotonin reuptake inhibitors (SSRI). After three months, nearly 55% of patients in the study improved when they switched antidepressant and participated in CBT. That study also found that after three months, about 41% of participants showed improvement after switching to either a different SSRI or to venlafaxine.

Dr Emslie and colleagues have now examined the six-month data from that study, and found that nearly 39% of participants who completed six months of treatment no longer had symptoms of depression. Those participants were more likely to have had lower levels of depression, hopelessness and anxiety at the beginning of the study.

Those who responded to the new regimen during the first three months were more likely to achieve remission. Many responded during the first six weeks of treatment.

Current guidelines suggest staying with a treatment for at least two to three months before trying another treatment. “In light of our new findings, those guidelines may need to be revisited because these latest results suggest more aggressive treatment early on may improve outcomes,” said Dr Emslie.